Defining Preoperative Hemoglobin Thresholds Can Help Avoid Transfusion or Adverse Events for Revision Total Joint...

Anemia optimization before revision total joint arthroplasty (rTJA) could improve outcomes; however, there is little literature on hemoglobin optimization efforts before rTJA. Simulation models in orthopaedic literature help define the likelihood of successful surgery based on thresholds of preoperative parameters. We evaluated whether certain preoperative hemoglobin thresholds could be defined for revision total knee arthroplasty (rTKA) and revision total hip arthroplasty (rTHA) in order to predict reduced likelihood of intraoperative or postoperative transfusion or perioperative adverse events.

We retrospectively reviewed consecutive rTKA and rTHA patients from 2019 to 2024. Exclusion criteria were primary arthroplasty, no preoperative hemoglobin, and incomplete 1-year follow-up. Preoperative hemoglobin values were used to determine the likelihood of transfusion (intraoperative and postoperative) and perioperative adverse outcome (defined as medical complication, surgical complication, readmission, or re-revision).

Preoperative hemoglobin was more sensitive and specific at defining the need for perioperative transfusion compared to perioperative adverse events. For both rTKA and rTHA, men required a higher preoperative hemoglobin threshold than women when predicting perioperative transfusion (rTKA: men 11.7 g/dL; area under the curve (AUC) 0.868 versus women 11.5 g/dL; AUC 0.887; rTHA: men 13.0 g/dL; AUC 0.776 versus women 12.0 g/dL; AUC 0.760) and perioperative adverse events (rTKA: men 13.8 g/dL AUC 0.693 versus women 12.50 g/dL; AUC 0.694; rTHA: men 12.3 g/dL AUC 0.571 versus women 11.9 g/dL; AUC 0.620). Higher hemoglobin thresholds were needed to prevent transfusion for aseptic cases (rTKA: 11.9 g/dL; rTHA: 12.0 g/dL) than septic cases (rTKA: 10.60 g/dL, rTHA: 10.9 g/dL).

To our knowledge, this is the first study to define preoperative hemoglobin thresholds in rTJA in order to attempt to reduce the likelihood of perioperative transfusion or adverse events. Future studies should further delineate preoperative hemoglobin thresholds in order to improve optimization efforts.